Worst month of their lives

Those were the feelings described by first-year medical students at A.T. Still University after navigating a reality in which they lived in poverty.

They spent Wednesday afternoon trying to find jobs, dealing with transportation and health care issues, turning their paychecks into cash, caring for children, putting food on their tables and keeping the lights on, filling out forms and standing in lines, hoping the mechanisms designed to help would kick in.

They did it for just a few hours as part of the third annual Poverty Simulation, hosted by the university's Complete Doctor course in conjunction with the Northeast Missouri Community Action Agency. Previously offered as an elective course, the event was recast this year to give all new ATSU students a glimpse inside the reality experienced by so many Americans in the hopes that when they become physicians they have developed a better understanding of the challenges patients can face.

"At KCOM we really have a strong thread of understanding vulnerable populations and patients the students will encounter," said Dr. Patricia Sexton, an associate professor in the university's Department of Family Medicine, Preventative Medicine and Community Health. "Because we're an osteopathic school and we believe in treating patient's mind, body and spirit, we approach people not just from symptoms but what is going on in their lives."

The students found out first hand just how much some are dealing with. The simulations placed students into different "families" and each had different real-world attributes. Some were employed, while others began the simulation homeless and had to work through the steps to gain access to housing. Some received assistance for disabilities. Some were recovering drug addicts, or had recovering addicts within their families.

With limited resources they needed to provide what many would consider bare necessities of life, and found challenges beyond their control. One student described a situation where he was employed and relying on public transportation, but the bus did not run on a given day and forced him to miss work. That single day, he said, threw off his entire financial structure for the month and placed his family in jeopardy.

The families experienced four weeks, each of which was played out in 15 minutes, and had three-minute weekends. During the weeks they needed to work or seek a job, provide care for their children and work through the various support agencies designed to assist. In many cases, they were greeted with long lines and longer applications, only to find out later they either didn't qualify for the assistance, needed to visit a different office, or the office was closed for a holiday on the day they needed help.

The lost time, with so much happening in their lives, caused stress obvious on many of their faces. Few students made it through the four-week simulation without losing some utilities, or even their homes. Fewer still managed to keep adequate food on their tables.

"This is absolutely reality for so many families in this county," said Jessica Stewart, family and community partnership supervisor with the NMCAA. "That frustration you felt in that moment is every day for these families.

Ethan Jaeger, a first-year student from St. Louis, played the role of a 50-year-old grandmother with a 52-year-old husband who was on disability. Jaeger had a full-time job making $9.50 an hour, and the couple needed to care for their grandchildren, ages 9 and 7, as their daughter was in a drug rehab clinic.

Jaeger said he learned a lot about the volume of work required just to care for a couple of children, regardless of a family's income. He also found out just how difficult it was to get out of poverty, even when dedicating significant energy to it.

"My 'family' I was assigned to, there were a lot of obstacles that couldn't be overcome because of time constraints, or we had to watch our kids, and as a future physician, seeing people coming into the clinic who are on Medicaid, that gives me a different perspective on how they're actually living," he said. "They've been dealt a hand that's unfortunate and they may be working as hard as they can to get out of it, but it's not going your way."

Stewart said that was part of the goal.

"If this helped you in any way to see people in a different light, not as 'bloodsucking Medicaid patients,' but as human beings, I think you took a lot away from this day," she told part of the students following the simulation.

NMCAA Executive Director Penny Miles shared that sentiment, saying she hoped as the students become doctors and move into their practices they gain a better understanding of their patients.

"Sometimes they don't have enough money to take their children to the doctor when they need to go and I want the physician to know that if they should have been there a month ago, it wasn't that maybe they didn't want to, it was maybe that they couldn't," Miles said.

Miles credited ATSU for expanding the simulation and wanting it to be experienced by so many of their students, and noted similar scenarios are done with Moberly Area Community College and Truman State students, among others.Sexton said it was something that should open some eyes.

"We all assume everyone's life is the same as ours because it's the only one we know," she said. "Most of these students, I doubt too many in the first-year class, have ever experienced these things themselves.

"I think this is a great opportunity to make the best primary care physician we possibly can."

By the numbers

15.9The percentage of Americans with an income below poverty in 2011, according to the U.S. Census. This equals 48.5 million people.

15.8 The percentage of Missourians living in poverty as of 2011. The number has increased steadily since 2000, when it was 10.6 percent.